This study investigates parents’ knowledge of food allergy management in their children and if use of an educational website increases knowledge. The Allergy and Immunology (AI) Clinic at University of Chicago provides a free educational website, AllergyGoAway.com, which aims to educate patients how to prevent, identify, and manage food allergic reactions and anaphylaxis. Parents of patients with food allergy completed surveys during a follow-up visit at AI Clinic. The survey inquired about confidence and knowledge of food allergy topics and use of the website. Confidence was measured using a 5-point Likert scale. Knowledge was assessed using questions pooled from a validated knowledge quiz out of 8 points. 68 subjects were surveyed and majority (>87%) were knowledgeable in avoidance and recognizing symptom severity. Knowledge was poor (< 56%) regarding timing and management of anaphylaxis. Subjects were confident identifying and preventing symptoms of food allergy and using epinephrine autoinjectors. They were not confident identifying signs of anaphylaxis and following a food allergy action plan. Only 7 subjects (10%) used the website, with no difference in knowledge between users and nonusers. Education during the patient encounter remains the standard to improve patient knowledge and should focus on specific warning signs of anaphylaxis, the importance of early intervention with epinephrine autoinjectors, and an allergy action plan to prevent fatality. Website use among the surveyed group was low. An online resource may not be sufficient to replace the education provided by healthcare workers during clinic visits.

Introduction: Olopatadine hydrochloride is an antihistamine and mast cell stabilizer available in three forms, including oral, intranasal and ocular preparations. Most of the practical applications focus on the use of olopatadine for the treatment of allergic rhinitis and conjunctivitis via intranasal and ocular routes. Areas covered: This article was formed from a comprehensive literature search with information taken from meta-analyses, systematic reviews, treatment guidelines and clinical studies on children and adults. Articles that have been selected evaluate the use of intranasal and ocular antihistamines and their role in allergic rhinitis and conjunctivitis. Expert opinion: Olopatadine is significantly more effective than placebos in alleviating the symptoms of allergic rhinitis and conjunctivitis. Olopatadine is a viable alternative and addition to the mainstay therapy of these conditions with intranasal steroids and oral antihistamines. The compliance of the patients would be improved if a once-per-day formulation of olopatadine was developed for intranasal application. The future treatments of allergic rhinitis will probably involve a combination of intranasal antihistamine and steroid because clinical trials have demonstrated an improved efficacy without a significant increase in adverse effects.

OBJECTIVES We examined racial and ethnic disparities in the total potential burden of asthma in low-income, racially/ethnically heterogeneous Chicago schools. METHODS We used the Brief Pediatric Asthma Screen Plus (BPAS+) and the Spanish BPAS+, validated, caregiver-completed respiratory questionnaires, to identify asthma and possible asthma among students in 14 racially/ethnically diverse public elementary schools. RESULTS Among 11490 children, we demonstrated a high lifetime prevalence (12.2%) as well as racial and ethnic disparities in diagnosed asthma, but no disparities in prevalences of possible undiagnosed asthma. Possible asthma cases boost the total potential burden of asthma to more than 1 in 3 non-Hispanic Black and Puerto Rican children. CONCLUSIONS There are significant racial and ethnic disparities in diagnosed asthma among inner-city schoolchildren in Chicago. However, possible undiagnosed asthma appears to have similar prevalences across racial/ethnic groups and contributes to a high total potential asthma burden in each group studied. A better understanding of underdiagnosis is needed to address gaps in asthma care and intervention for low-income communities.

Background: The health and health care needs of non-English-speaking Hispanic families with children are poorly understood, in part because they are often excluded from research owing to language barriers. Instruments that are valid in English and Spanish are necessary to accurately evaluate the magnitude of asthma prevalence and morbidity among Hispanics.Objective: To establish the sensitivity and specificity of the English and Spanish versions of the asthma portion of the Brief Pediatric Asthma Screen Plus (BPAS+) in a low-income Hispanic population.Methods: The validation sample consisted of 145 children whose parents completed the BPAS+ in Spanish and 78 whose parents completed it in English. Bilingual clinicians conducted the examinations on which the clinical assessments were based. We compared the BPAS+ results with the clinical assessment findings to determine the sensitivity and specificity of the BPAS+ among Hispanics in terms of identifying children who warrant further medical evaluation for asthma.Results: The sensitivity and specificity of the asthma portion of the Spanish BPAS+ were 74% and 86%, respectively. The sensitivity and specificity of the asthma portion of the English BPAS+ were 61% and 83%, respectively.Conclusions: The asthma portion of the BPAS+, a valid screen for identifying children who are in need of further evaluation for potentially undiagnosed asthma, is valid for low-income Hispanics in Spanish and English. As the Hispanic population continues to grow, it is imperative that researchers have English and Spanish instruments that are valid for this population.

RATIONALE Recent genetic studies have implicated integrins in asthma and atopy susceptibility. We therefore evaluated the integrin-beta3 gene (ITGB3), an integrin gene within an asthma linkage peak on chromosome 17, as a candidate for susceptibility to asthma- and atopy-related phenotypes. METHODS AND MEASUREMENTS We genotyped and performed association tests on 19 single nucleotide polymorphisms in ITGB3 in the Hutterites, a founder population, and in three outbred replication populations. MAIN RESULTS Variation in ITGB3 was strongly associated with susceptibility to bronchial hyperresponsiveness and protection from allergic sensitization to mold allergens in this population. Three independent case-control populations representing Caucasians and African Americans were used to replicate this finding, also revealing ITGB3 alleles that are associated with asthma susceptibility and protection from mold allergen sensitization. CONCLUSIONS This study provides evidence that ITGB3 plays a role in the pathogenesis of asthma and sensitization to mold allergens.

Asthma affects nearly 14 million people worldwide and has been steadily increasing in frequency for the past 50 years. Although environmental factors clearly influence the onset, progression, and severity of this disease, family and twin studies indicate that genetic variation also influences susceptibility. Linkage of asthma and related phenotypes to chromosome 6p21 has been reported in seven genome screens, making it the most replicated region of the genome. However, because many genes with individually small effects are likely to contribute to risk, identification of asthma susceptibility loci has been challenging. In this study, we present evidence from four independent samples in support of HLA-G as a novel asthma and bronchial hyperresponsiveness susceptibility gene in the human leukocyte antigen region on chromosome 6p21, and we speculate that this gene might contribute to risk for other inflammatory diseases that show linkage to this region.

Atopy is an IgE-mediated condition known to aggregate in families and is a major risk factor for asthma. As part of the Collaborative Study on the Genetics of Asthma (CSGA), a genome-wide scan for atopy, defined by skin sensitivity to one or more common environmental allergens, was conducted in 287 CSGA families (115 African American, 138 Caucasian and 34 Hispanic). Using a nonparametric genetic analysis approach, two regions were observed in the sample of all families that yielded multipoint lod scores >1.5 (chromosome 11q, lod=1.55 between D11S1986 and D11S1998; chromosome 20p between D20S473 and D20S604, lod=1.54). Modeling that included multiple genomic positions simultaneously indicated that four chromosomal regions accounted for the majority of evidence for linkage in the combined families. These four regions are on chromosomes 10p near D10S1412 (lod=0.94), 11q near D11S1986 (lod=1.76), 17q near D17S784 (lod=0.97) and 20p near D20S473 (lod=1.74). In the subset of pedigrees giving positive evidence for linkage on chromosome 11q, the evidence for linkage increased by lod scores greater than one in four other chromosomal regions: 5q (D5S1480, lod=1.65), 8p (D8S1113, lod=1.60), 12p (D12S372, lod=1.54) and 14q (D14S749, lod=1.70). These results suggest that several regions may harbor genes contributing to the risk for atopy and these may interact with one another in a complex manner.

Background: Asthma and allergies are commonly undiagnosed in children. Schools provide settings for potentially accessing almost all children for asthma and allergy screening.Objective: To evaluate the feasibility and validity of using a questionnaire-based screening tool to identify undiagnosed asthma and respiratory allergies in children in kindergarten to grade 6.Methods: A student questionnaire (SQ) and a parent questionnaire (PQ) were developed, administered in 4 diverse communities, and validated against standardized clinical assessments. Children without diagnosed asthma and representing a range of symptoms participated in a validation study that consisted of independent, standardized, clinical assessments. Sensitivity, specificity, and predictive values for questionnaire items were evaluated against expert consensus designations.Results: A total of 190 children (age range, 7-13 years) completed the validation study. Affirmative responses to individual questions from either the SQ or PQ regarding asthma and allergy were modestly to moderately predictive of the clinical assessments (odds ratios, generally 2.5-5.0). When considering a positive asthma screen as affirmative responses to 3 of the best 7 SQ asthma questions, the odds ratio for asthma was 9.3 (95% confidence interval, 4.1-21.1), with 80% sensitivity and 70% specificity. Considering the allergy screen as positive based on affirmative response to either of the 2 SQ allergy questions yielded 81% sensitivity and 42% specificity.Conclusions: Either a 9-item SQ or a 10-item PQ can be used in diverse settings to screen for asthma and respiratory allergies. The SQ, obtained by directly screening students, may provide a sensitive approach for detecting children with previously undiagnosed asthma and allergies.

Management of Allergic and Asthmatic EmergenciesDiagnostic Techniques in Pediatric Allergy and AsthmaBasisTestsAllergyRhinitisDifferential diagnosisApproach to diagnosisManagementMedicationAsthmaEarly childhood wheezingDiagnosis and Differential Diagnosis of Asthma Management of AsthmaGeneralAcuteLong-termMedicationsDelivery systemsAllergic swellingPresentationUrticariaAngioedemaAnaphylaxisCausesFoodDrugs LatexInsect stings AssessmentManagementAtopic skin diseaseEczemaContact dermatitisDrug reactionsUnconventional allergic reactionsHypersensitivity pneumonitisImmune complex diseaseEnvironmental controlPatient educationIndications for Allergy ImmunotherapyImmunologyThe Approach to the Child with Recurrent InfectionsImmune System DefectsCongenitalAcquiredImmune investigationManagement of Common Immune disorders

Background: In the Collaborative Study on the Genetics of Asthma, 314 families with 2584 subjects were characterized for asthma and allergy. Objective: The purpose of this investigation was to examine clinical heterogeneity observed in asthma and allergic characteristics among 3 ethnic groups (African American, white, and Hispanic family members). Methods: Pulmonary function parameters and asthmaassociated phenotypes were compared among the ethnic groups. Results: In comparison with the other groups, African American sibling pairs had a significantly lower baseline FEV1 percent of predicted (P = .0001) and a higher rate of skin test reactivity to cockroach allergen (P = .0001); Hispanic sibling pairs had significantly more skin reactivity overall (P = .001); and white sibling pairs had significantly lower total serum IgE (P < .05). In addition, there were significantly more relatives with asthma among the African American families than among the white and the Hispanic families (P = .001). Conclusion: Although different environmental backgrounds should be considered, these clinical differences could be due to differences in genetic susceptibility among the ethnic groups, such as those suggested by our previous genome screen. (J Allergy Clin Immunol 2001;108:357-62.)

OBJECTIVETo examine the relationships among demographic characteristics, caregiver life stressors, and depressive symptoms of mothers and their children's asthma morbidity.SETTINGThree pediatric asthma subspecialty programs, 2 in the inner city and 1 in the suburbs.DESIGNCross-sectional census sample of caregivers of children with asthma: interviews mostly with mothers (N = 123) regarding their children's asthma symptoms and health care utilization. Information collected on demographics and caregivers' own recent life stressors and depressive symptoms.SUBJECTSCaregivers of children ages 18 months to 12 years with asthma at their subspecialty visit.MEASURESStructured interviews: a survey instrument prepared for this study and standardized instruments for depression (Center for Epidemiologic Studies--Depression) and life stressors (Crisis in Family Systems).RESULTSA total of 32% of respondents' children had high asthma morbidity, 28% intermediate, and 40% low. Caregiver life stressors and depression and the children's sex showed the strongest relationships to asthma morbidity in a model that also included race, residence, and Medicaid status. Children were more likely to have high morbidity if they had caregivers with more depressive symptoms and negative life stressors and if they were female.CONCLUSIONSRespondents experienced many life stressors and symptoms of depression while managing their children's illness. Caregivers' lives may affect their children's asthma morbidity, offering empirical evidence for the potential value of targeted case management for children in subspecialty care.

The objectives of this study were to establish the validity of the Crisis in Family Systems-Revised, a recently developed measure of contemporary life stressors, using the same validation technique as in the original validation and to provide further evidence of construct validity by assessing its relationship to socioeconomic status and residential location. We conducted 124 in-person interviews with parents in three outpatient pediatric asthma clinics affiliated with an academic medical center. The design was cross-sectional and correlational. Total count of life stressors accounted for 19% of the variance in scores on the Center for Epidemiologic Studies-Depression. Respondents using Medicaid and living in the city experienced more objective stressors, but the proportions of stressors rated as negative or positive (Valence), and ongoing (Chronicity) were fairly constant across subsamples, as was the Difficulty rating. Psychologists and health and mental health services researchers are in need of constructs relevant to contemporary society and its issues and tools to measure these constructs. Life stressors appears to be such a construct and the Crisis in Family Systems-Revised a measure with considerable utility.

STUDY OBJECTIVES The purpose of this study was to confirm the validity of a brief screen for pediatric asthma in schools. BACKGROUND Asthma is the most common chronic disease of childhood, yet the frequency with which this condition is recognized among school-aged children varies widely. Several methods are used to increase the accuracy of detection of asthma, but many are cumbersome and difficult to apply on a large scale. DESIGN We elected to validate a five-question instrument, the Brief Pediatric Asthma Screen (BPAS), to screen for the presence of asthma among children attending school in Region 5 of the Chicago school district, where the schools report a 2.7% frequency of asthma. The questionnaire was distributed to the parents of grade-school children at the time of report-card pick-up. SETTING A clinical assessment was performed on a selected group of children whose parents completed the questionnaire in a school and in a hospital outpatient clinic. PARTICIPANTS Of 4,147 questionnaires that we distributed, 1,796 (43%) were returned. We excluded 341 children (19% of the total sample) whose parents reported that they had been diagnosed with asthma. The remaining pool indicated that the children of 183 responders (10%) had symptoms suggestive of asthma, while 1,272 parents (71%) indicated that their children did not have symptoms of asthma. MEASUREMENTS AND RESULTS We selected 90 of the respondents who did not indicate that their children had a diagnosis of asthma. Of this group, 81 completed the validation, in which their responses suggested symptoms of asthma (n = 34) or no asthma symptoms (n = 47). The children of these respondents were given a blinded clinical evaluation consisting of history, physical examination, and spirometry. The survey demonstrated a sensitivity of 75% and a specificity of 81.2% for the presence of asthma among those who were unaware of the diagnosis. CONCLUSIONS The BPAS is brief, can be filled out by parents, and appears accurate in detecting asthma.

The importance of asthma as a major factor affecting the quality of life in Chicago school children has been recognized for many years. The prevalence of asthma is high, with 16% of seventh- and eighth-grade students from 1994 to 1995 having received diagnoses of the disease, 18% having wheezed in the last year, and 11% of students having missed school in the last year because of asthma. 1 Persky V Slezak J Contreras A et al. Relationships of race and socioeconomic status with prevalence, severity and symptoms of asthma in Chicago school children. Ann Allergy Asthma Immunol. 1998; 81: 266-271 Abstract Full Text PDF PubMed Scopus (123) Google Scholar Differences exist among groups, with 13% of Catholic school children, 17% of public school children, and 22% of children in school with census tracts with > 40% of families below poverty in Chicago having received diagnoses of asthma. These differences in asthma prevalence, however, are far less than differences in asthma mortality, suggesting that some of the factors affecting asthma may be modifiable.

The Chicago Asthma Consortium is a group that oversees and attempts to improve the outcomes for the asthmatic population of the city of Chicago and is designed to respond to the perceived needs of this community. It has more than 300 members who operate through six standing committees and in its first year of operation, the Chicago Asthma Consortium has seen notable successes, such as the effecting of a change in a restrictive policy on medication use by students in the Chicago public schools. We describe here the details of the function of the Chicago Asthma Consortium and give examples of its effectiveness in dealing with this common, yet complex, disease.

ABSTRACT: We examined normal human placenta for an immunologic function by measuring the release of soluble inhibitory factor (SIF). SIF is a product of normal T lymphocytes and of the JEG-3 choriocarcinoma cell line, and blocks proliferative and antibody-producing responses of mononuclear cells. SIF can be further characterized by a noncovalently linked subcomponent, lipid suppressor substance. The villous surfaces of six normal human placentae were digested with collagenase to obtain a population of predominantly multinucleated giant cells. These cells were maintained in standard culture for 5 days after which the cell-free conditioned culture medium was assayed for SIF content by measuring suppression of [3H] thymidine incorporation into lymphocytes stimulated by low-dose phytohemagglutinin. Undiluted placental SIF induced 88% inhibition of this response (p < 0.001). The placental SIF was found to contain lipid suppressor substance, as does SIF from mononuclear cells. We determined this by thin-layer chromatography where a peak of suppressive activity occurred at Rf 0.32 ([3H]thymidine incorporation reduced from 21810 ± 308 to 4121 ± 214 cpm); this is the position on thin-layer chromatography to which mononuclear cell lipid suppressor substance migrates. Ion exchange chromatography comparing the elution patterns of lymphocyte-SIF and placental-SIF indicated that both eluted in the fraction of 40–50 mM POx4 buffer, further suggesting identity between these two substances. SIF from placental and lymphocyte sources functioned by inducing the presence of suppressor cells in culture. Mononuclear cells were incubated for 48 h in SIF; the resultant cell population reduced [H3]thymidine incorporation into phytohemagglutinin-stimulated lymphocytes from 21170 ± 1721 to 8612 ± 311 cpm (60% inhibition, p < 0.001). Adherent cells were not required for function of these cells and they were not sensitive to mitomycin C. The placenta helps prevent immunologic rejection of the fetus by several mechanisms; it functions as a barrier, it is devoid of human histocompatibility leukocyte antigen markers and it has immunologic functions. The studies presented herein indicate that the placenta releases a substance that induces the formation of suppressor cells. These data support the hypothesis that placental cells have an immunoregulatory function.

A normal fetus is an allograft, yet is tolerated by maternal immunological mechanisms. We have used soluble inhibitory factor (SIF) to study this phenomenon. SIF, a product of normal T lymphocytes and of the JEG-3 choriocarcinoma cell line, blocks proliferative and antibody-producing responses of mononuclear cells. The villous surface of 5 normal human placentae was digested with collagenase to free cells that were predominantly multinucleated giant cells. After 5 days of standard culture, we assayed cell-free conditioned culture medium (CdM) for SIF content by measuring suppression of [3H] thymidine incorporation ([3H]TD-I) into lymphocytes stimulated by low-dose phytohemagglutinin. Significant suppression (p<0.001) was noted: 25,847±8,007 cpm (mean±SD) was reduced to 359±272 cpm by full-strength CdM and to 3,474±1,949 cpm by half-strength CdM. SIF can be characterized by a noncovalently linked subcomponent, lipid suppressor substance, which was isolated from SIF in CdM by extraction into organic solvents and by thin-layer chromatography. SIF also appears to suppress lymphocyte response via a subpopulation of mononuclear cells. SIF-CdM likewise induced the development of cells that suppressed [3H]Td-I from 30,625±3,013 cpm to 14,487±1,496 cpm. Normal placental multinuclear cells thus release an SIF-like substance into culture fluid. Our findings support the hypothesis that the placenta modifies maternal immunologic mechanisms of rejection. Aided by Basil O'Connor Starter Research Grant #5-347, March of Dimes Birth Defects Foundation.